Chief Investigator: Dr Natasha Campling, University of Southampton

Funder: Marie Curie Research Grants Scheme

Start Date: 1st March 2023

End Date: 7th January 2026

Partners: University of Southampton, University of the West of England, South East Coast Ambulance Service NHS Foundation Trust, University of Ulster, Northern Ireland Ambulance Service Health and Social Care Trust, Marie Curie.

Why did we do this work?

Demand for end-of-life care (for people in the last year of life) is rising, driven by ageing population and increasing rates of people living with multiple conditions. This is causing increases in 999 calls to ambulance services with rates highest in areas of deprivation. In line with this rise in 999 calls for those at end of life, rates of ambulances transporting people to hospital are also increasing, which can lead to hospital deaths, a place where most people say they do not wish to die. Despite this little is known about paramedic practice in this context and service provision varies widely. 

What did we do?

The study has for the first time investigated how ambulance paramedics support people in the last year of life following a 999 call, what challenges they face, and how services can best enable effective, compassionate care.  More than 1,100 paramedics responded to a survey and over 100 patients, carers and healthcare professionals were interviewed.

What did we find out?

• Ambulance paramedics provide supportive and compassionate care to individuals at end of life, but practice hampered by limited access to essential resources (specialist advice, patient records, advance care planning documents and medicines).

• Fear and uncertainty regarding end-of-life care undermine paramedic confidence.

• Limited education and training in palliative and end of life care contribute to skill and knowledge gaps.

• Gaps in access to other healthcare professionals mitigate against shared professional decision-making.   

• Challenges with medicines access and administration impede symptom control by paramedics.

• Service shortages in primary, community and specialist palliative care services drive paramedic call outs and challenges in interdisciplinary collaboration limit quality of care.

We have:

• Contributed evidence to Government’s consultation on proposals to extend medicines responsibilities for paramedics.

• Submitted written evidence to Palliative Care Commission focused on increasing paramedic confidence and coordination of paramedic delivered care at end of life.

• Secured follow on funding to deploy the survey developed and used in the study to understand the situation for ambulance paramedics in Northern Ireland. 

Marie Curie led press release November 2025 (to coincide with the publication of the ParAid policy brief) Urgent reform needed to support ambulance delivered end of life care.  This led to national and regional radio interviews by the ParAid study CI and Marie Curie’s Director of Policy and Research.

University of Southampton and Marie Curie press release February 2025 (following the publication of the findings of the ParAid national survey in England).  This led to a wide range of news outlet outputs including BBC news online.

Publications: Campling, N., Turnbull, J., Richardson, A. et al. Paramedics providing end-of-life care: an online survey of practice and experiences. BMC Palliat Care 23, 297 (2024). https://doi.org/10.1186/s12904-024-01629-7